Original article| Volume 23, ISSUE 3, P484-496, March 1934

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The concept of pyloric balance in ileus

Treated by continuous suction from the stomach
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      • 1.
        1. Ileus following abdominal operations is in our experience almost always due to peritonitis.
      • 2.
        2. Tonus is of much greater importance than peristalsis in determining the ability of the gut to recover in ileus. The ability of the obstructed intestine to empty its contents into the stomach is an indication that it retains its tonus, even after peristalsis has disappeared.
      • 3.
        3. A simplified apparatus for maintaining continuous positive suction from the stomach contents is presented; its use and the necessary calculations are explained.
      • 4.
        4. A concept of “pyloric balance,” expressing the direction of the predominating current of fluid through the pyloric ring, is introduced. This is essentially an expression of the sum of two varying factors: intestinal tonus and degree of obstruction.
      • 5.
        5. Quantitative measurement of a negative pyloric balance and its conversion into a positive balance are attained most quickly and most certainly by the employment of continuous positive suction alone or in conjunction with enterostomy (the additional use of “replacement therapy” is taken for granted).
      • 6.
        6. The data on 3 illustrative cases are presented in detail.
      • 7.
        7. Increasing experience with this method of treatment indicates that there is a large group of patients with intestinal obstruction in which the risk of death is far less if decompression of the bowel is brought about by continuous suction of the stomach than if operation is performed within more than a very few hours of onset.
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